American journal of preventive medicine

Publications in this journal

• Article: Measurement in Comparative Effectiveness Research.

  Jessica Chubak, Carolyn M Rutter, Aruna Kamineni, Eric A Johnson, Natasha K Stout, Noel S Weiss, V Paul Doria-Rose, Chyke A Doubeni, Diana S M Buist
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  ABSTRACT: Comparative effectiveness research (CER) on preventive services can shape policy and help patients, their providers, and public health practitioners select regimens and programs for disease prevention. Patients and providers need information about the relative effectiveness of various regimens they may choose. Decision makers need information about the relative effectiveness of various programs to offer or recommend. The goal of this paper is to define and differentiate measures of relative effectiveness of regimens and programs for disease prevention. Cancer screening is used to demonstrate how these measures differ in an example of two hypothetical screening regimens and programs. Conceptually and algebraically defined measures of relative regimen and program effectiveness also are presented. The measures evaluate preventive services that range from individual tests through organized, population-wide prevention programs. Examples illustrate how effective screening regimens may not result in effective screening programs and how measures can vary across subgroups and settings. Both regimen and program relative effectiveness measures assess benefits of prevention services in real-world settings, but each addresses different scientific and policy questions. As the body of CER grows, a common lexicon for various measures of relative effectiveness becomes increasingly important to facilitate communication and shared understanding among researchers, healthcare providers, patients, and policymakers.
  American journal of preventive medicine 05/2013; 44(5):513-519.
• Article: Type-Specific Screen Time Associations with Cardiovascular Risk Markers in Children.

  Emmanuel Stamatakis, Ngaire Coombs, Russell Jago, Augusta Gama, Isabel Mourão, Helena Nogueira, Vítor Rosado, Cristina Padez
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  ABSTRACT: BACKGROUND: There is evidence that TV time may have stronger associations with cardiovascular risk markers than other types of screen time, but most studies focus on TV, or total screen time. PURPOSE: To examine associations between types of screen time and cardiovascular risk markers in school-age children. METHODS: Cross-sectional study of 2515 school children in Portugal (aged 2-12 years, data collected in 2009 and 2010). Three types of screen time (TV, electronic games, and PC time) were collected through a questionnaire, and data on three cardiovascular risk markers (resting heart rate; diastolic blood pressure [DBP]; and systolic blood pressure [SBP]) were collected by a trained fieldworker. Complex-samples generalized linear models were run for each combination of screen time predictor and cardiovascular risk outcome, and a clustered cardiovascular risk score, adjusting for potential confounders (including physical activity). Analyses were conducted in 2011 and 2012. RESULTS: TV viewing, but not PC or electronic games time, was associated positively with clustered cardiovascular risk score, DBP, and SBP after adjustment for all covariates. Watching TV for >2 hours/day (compared to <1 hour/day) was associated with higher DBP (coefficient, logged and back-transformed 0.02, 95% CI=0.00, 0.04, linear trend p=0.003); SBP (logged and back-transformed 0.02, 95% CI= -0.01, 0.05, p=0.009), and clustered cardiovascular risk score (0.13, 95% CI=0.02, 0.24, p<0.001). CONCLUSIONS: TV viewing, but no other type of screen time, was associated positively with cardiovascular risk markers independently of physical activity. Studies using a single marker of screen time or sedentary behavior may conceal screen time type-specific associations.
  American journal of preventive medicine 05/2013; 44(5):481-488.
• Article: The U.S. National Physical Activity Plan: Dissemination and Use by Public Health Practitioners.

  Kelly R Evenson, Ross C Brownson, Sara B Satinsky, Amy A Eyler, Harold W Kohl
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  ABSTRACT: BACKGROUND: The 2010 U.S. National Physical Activity Plan contains a comprehensive set of policies, programs, and initiatives to increase physical activity. PURPOSE: To determine the early awareness, use, diffusion, and implementation of the plan among members of the National Society of Physical Activity Practitioners in Public Health. METHODS: The web-based survey was conducted in 2011 and analyzed in 2011-2012. The survey was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and Diffusion of Innovations theory. Of 492 professional members, 291 responded. RESULTS: Overall, 79% reported awareness of the plan, with higher odds among state practitioners compared to other practitioners and among those with state partnerships to address physical activity compared to those without. Among those who were aware (n=230), 15% reported using the plan ≥6 times, whereas 28% had never used it. For those who referred to the plan at least once in their work (n=165), the most commonly reported uses were for brainstorming and discussion (73%); development and implementation of activities (55%); and state-level goal-setting (34%). Related to diffusion principles, many respondents reported that the plan fit their organization's goals (85%) and was easy to understand (81%), yet fewer agreed that changes made after the plan were easy to observe (32%); easy to implement (28%); and low-cost (25%). CONCLUSIONS: This theory-based evaluation found that the National Physical Activity Plan has been broadly disseminated to physical activity practitioners working in public health. Opportunities exist for public health practitioners and others to more fully integrate the plan into their work.
  American journal of preventive medicine 05/2013; 44(5):431-438.
• Article: Post-Traumatic Stress Disorder: Review of the Comprehensive Soldier Fitness Program.

  Maria M Steenkamp, William P Nash, Brett T Litz
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  ABSTRACT: Since the start of the wars in Afghanistan and Iraq, the U.S. military has implemented several population-based initiatives to enhance psychological resilience and prevent psychological morbidity in troops. The largest of these initiatives is the Army's Comprehensive Soldier Fitness (CSF) program, which has been disseminated to more than 1 million soldiers. However, to date, CSF has not been independently and objectively reviewed, and the degree to which it successfully promotes adaptive outcomes and prevents the development of deployment-related mental health disorders such as post-traumatic stress disorder (PTSD) is uncertain. This paper critically evaluates the theoretic foundation for and evidence supporting the use of CSF.
  American journal of preventive medicine 05/2013; 44(5):507-512.
• Article: Public Health and the Green Building Industry: Partnership Opportunities for Childhood Obesity Prevention.

  Matthew J Trowbridge, Terry T-K Huang, Nisha D Botchwey, Thomas R Fisher, Chris Pyke, Anne B Rodgers, Rachel Ballard-Barbash
  American journal of preventive medicine 05/2013; 44(5):489-495.
• Article: Worksite Interventions: Improving Lifestyle Habits Among Latin American Adults.

  Setoo Mehta, Jonathan Dimsdale, Brian Nagle, Christina K Holub, Corinne Woods, Simón Barquera, John P Elder
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  ABSTRACT: CONTEXT: Worksite-based interventions have been shown to result consistently in significant improvements in weight- and health-related outcomes among the working adult population; however, applicability and effectiveness of studies has often been limited by inadequate reporting of age and ethnicity. This study aimed to examine work-based interventions among Latinos in the U.S. and Latin America. EVIDENCE ACQUISITION: Data were abstracted (and analyzed) from "parent" study Guide to Obesity Prevention in Latin American and the U.S. (GOL), between January 2010 and December 2011. Manuscripts from 1965 to 2010 were evaluated according to inclusion criteria for interventions, including a sample population of at least 50% Latinos or results stratified by ethnicity, at least one obesity-related outcome measure evaluated before and after intervention, and worksite setting and comparison of an intervention group to a non-intervention group (including pre-post designs). EVIDENCE SYNTHESIS: Of 105 interventions abstracted, five were work-based interventions. The average participant age was 45 years, with an average of 58% women. Four of the five interventions had a pre-post study design that received a fair execution score and lowest design-suitability score, whereas one group RCT intervention had the greatest design suitability and good execution. For two studies, Cohen's d effect sizes ranged from 0.09 to 0.603. Effect sizes could not be calculated for three of the interventions. Three interventions found significant outcomes for BMI, three for weight, two for waist circumference, and one for waist-to-hip ratio. CONCLUSIONS: Few studies have focused on work-based interventions specifically aimed at Latinos. This review identified promising strategies for reducing obesity in the workplace.
  American journal of preventive medicine 05/2013; 44(5):538-542.
• Article: Obesity Control in Latin American and U.S. Latinos: A Systematic Review.

  Christina K Holub, John P Elder, Elva M Arredondo, Simón Barquera, Christina M Eisenberg, Luz María Sánchez Romero, Juan Rivera, Felipe Lobelo, Eduardo J Simoes
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  ABSTRACT: CONTEXT: Latinos are the largest and fastest-growing ethnically diverse group in the U.S.; they are also the most overweight. Mexico is now second to the U.S. in experiencing the worst epidemic of obesity in the world. Objectives of this study were to (1) conduct a systematic review of obesity-related interventions targeting Latinos living in the U.S. and Latin America and (2) develop evidence-based recommendations to inform culturally relevant strategies targeting obesity. EVIDENCE ACQUISITION: Obesity-related interventions, published between 1965 and 2010, were identified through searches of major electronic databases in 2010-2011. Selection criteria included evaluation of obesity-related measures; intervention conducted in a community setting; and at least 50.0% Latino/Latin American participants, or with stratified results by race/ethnicity. EVIDENCE SYNTHESIS: Body of evidence was based on the number of available studies, study design, execution, and effect size. Of 19,758 articles, 105 interventions met final inclusion criteria. Interventions promoting physical activity and/or healthy eating had strong or sufficient evidence for recommending (1) school-based interventions in the U.S. and Latin America; (2) interventions for overweight or obese children in the healthcare context in Latin America; (3) individual-based interventions for overweight or obese adults in the U.S.; (4) individual-based interventions for adults in Latin America; and (5) healthcare-based interventions for overweight or obese adults in Latin America. CONCLUSIONS: Most intervention approaches combined physical activity and healthy eating to address both sides of the energy-balance equation. Results can help guide comprehensive evidence-based efforts to tackle the obesity epidemic in the U.S. and Latin America.
  American journal of preventive medicine 05/2013; 44(5):529-537.
• Article: Cigarette Price-Minimization Strategies by U.S. Smokers.

  Xin Xu, Michael F Pesko, Michael A Tynan, Robert B Gerzoff, Ann M Malarcher, Terry F Pechacek
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  ABSTRACT: BACKGROUND: Smokers may react to cigarette excise tax increases by engaging in price-minimization strategies (i.e., finding ways to reduce the cost of cigarette smoking) rather than by quitting or reducing their cigarette use, thereby reducing the public health benefits of such tax increases. PURPOSE: To evaluate the state and national prevalence of five common cigarette price-minimization strategies and the size of price reductions obtained from these strategies. METHODS: Using data from the 2009-2010 National Adult Tobacco Survey, the prevalence of five common price-minimization strategies by type of strategy and by smoker's cigarette consumption level were estimated. The price reductions associated with these price-minimization strategies also were evaluated. Analyses took place in November 2012. RESULTS: Approximately 55.4% of U.S. adult smokers used at least one of five price-minimization strategies in the previous year, with an average reduction of $1.27 per pack (22.0%). Results varied widely by state. CONCLUSIONS: Cigarette price-minimization strategies are practiced widely among current smokers, and resulting price reductions are relatively large. Policies that decrease opportunities to effectively apply cigarette price-minimization strategies would increase the public health gains of cigarette excise tax increases.
  American journal of preventive medicine 05/2013; 44(5):472-476.
• Article: A Quality Improvement Evaluation Case Study: Impact on Public Health Outcomes and Agency Culture.

  William C Livingood, Radwan Sabbagh, Steve Spitzfaden, Angela Hicks, Lucy Wells, Suzannah Puigdomenech, Dale F Kramer, Ryan Butterfield, William Riley, David L Wood
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  ABSTRACT: BACKGROUND: Quality improvement (QI) is increasingly recognized as an important strategy to improve healthcare services and health outcomes, including reducing health disparities. However, there is a paucity of evidence documenting the value of QI to public health agencies and services. PURPOSE: The purpose of this project was to support and assess the impact on the outcomes and organizational culture of a QI project to increase immunization rates among children aged 2 years (4:3:1:3:3:1 series) within a large public health agency with a major pediatric health mission. METHODS: The intervention consisted of the use of a model-for-improvement approach to QI for the delivery of immunization services in public health clinics, utilizing plan-do-study-act cycles and multiple QI techniques. A mixed-method (qualitative and quantitative) model of evaluation was used to collect and analyze data from June 2009 to July 2011 to support both summative and developmental evaluation. The Florida Immunization Registry (Florida SHOTS [State Health Online Tracking System]) was used to monitor and analyze changes in immunization rates from January 2009 to July 2012. An interrupted time-series application of covariance was used to assess significance of the change in immunization rates, and paired comparison using parametric and nonparametric statistics were used to assess significance of pre- and post-QI culture items. RESULTS: Up-to-date immunization rates increased from 75% to more than 90% for individual primary care clinics and the overall county health department. In addition, QI stakeholder scores on ten key items related to organizational culture increased from pre- to post-QI intervention. Statistical analysis confirmed significance of the changes. CONCLUSIONS: The application of QI combined with a summative and developmental evaluation supported refinement of the QI approach and documented the potential for QI to improve population health outcomes and improve public health agency culture.
  American journal of preventive medicine 05/2013; 44(5):445-452.
• Article: U.S. Alcohol Affordability and Real Tax Rates, 1950-2011.

  William C Kerr, Deidre Patterson, Thomas K Greenfield, Alison Snow Jones, Kerry Anne McGeary, Joseph V Terza, Christopher J Ruhm
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  ABSTRACT: BACKGROUND: The affordability of alcoholic beverages, determined by the relationship of prices to incomes, may be an important factor in relation to heavy drinking, but little is known about how affordability has changed over time. PURPOSE: To calculate real prices and affordability measures for alcoholic beverages in the U.S. over the period from 1950 to 2011. METHODS: Affordability is calculated as the percentage of mean disposable income required to purchase 1 drink per day of the cheapest spirits, as well as popular brands of spirits, beer, and wine. Alternative income and price measures also are considered. Analyses were conducted in 2012. RESULTS: One drink per day of the cheapest brand of spirits required 0.29% of U.S. mean per capita disposable income in 2011 as compared to 1.02% in 1980, 2.24% in 1970, 3.61% in 1960, and 4.46% in 1950. One drink per day of a popular beer required 0.96% of income in 2010 compared to 4.87% in 1950, whereas a low-priced wine in 2011 required 0.36% of income compared to 1.05% in 1978. Reduced real federal and state tax rates were an important source of the declines in real prices. CONCLUSIONS: Alcoholic beverages sold for off-premises consumption are more affordable today than at any time in the past 60 years; dramatic increases in affordability occurred particularly in the 1960s and 1970s. Declines in real prices are a major component of this change. Increases in alcoholic beverage tax rates and/or implementing minimum prices, together with indexing these to inflation could be used to mitigate further declines in real prices.
  American journal of preventive medicine 05/2013; 44(5):459-464.
• Article: Screening Participation Predictors for People at Familial Risk of Colorectal Cancer: A Systematic Review.

  Driss Ait Ouakrim, Trevor Lockett, Alex Boussioutas, Louise Keogh, Louisa B Flander, John L Hopper, Mark A Jenkins
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  ABSTRACT: CONTEXT: People with a family history of colorectal cancer (CRC) are at increased risk of developing the disease. Information on the screening practices of this segment of the population is scarce. EVIDENCE ACQUISITION: A systematic review was conducted of observational studies to identify factors associated with CRC screening participation for people at increased risk due to family history of the disease.MEDLINE, Cinahl Information Sevices, Embase, and PsycINFO databases were searched comprehensively between January 1995 and May 2012 to identify relevant articles. To be included, studies had to report on screening for people who had at least one first-degree relative with CRC, have described the study design, and reported on at least two predictors of adherence to CRC screening using a multivariate analysis. EVIDENCE SYNTHESIS: The search identified a total of 4986 articles, of which ten met the review's inclusion criteria. There were important inconsistencies among studies in the factors that were associated with screening. Receiving recommendations from clinicians was the most consistent predictor identified across studies. The review also revealed a consistent pattern of association with predictors related to familial aspects of CRC, such as strength of family history, and relationship to the affected relative. Among the psychological constructs, "social influence" emerged as the most consistent predictor of screening participation. CONCLUSIONS: This review provides evidence that clinicians, as well as use of family history and social networks, offer the most promising avenues to promoting and improving screening participation by individuals at increased risk of colorectal cancer.
  American journal of preventive medicine 05/2013; 44(5):496-506.
• Article: Author Response.

  James F Thrasher, Jeannette O Andrews, Daniela B Friedman, Matthew J Carpenter, Kevin M Gray, K Michael Cummings, Anthony J Alberg, Ashley Navarro
  American journal of preventive medicine 05/2013; 44(5):e51-e53.
• Article: Evidence-Based Obesity Treatment Interventions for Latino Adults in the U.S.: A Systematic Review.

  Lilian G Perez, Elva M Arredondo, John P Elder, Simón Barquera, Brian Nagle, Christina K Holub
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  ABSTRACT: CONTEXT: Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults. EVIDENCE ACQUISITION: Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study. EVIDENCE SYNTHESIS: Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions. CONCLUSIONS: Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.
  American journal of preventive medicine 05/2013; 44(5):550-560.
• Article: Meeting Physical Activity Guidelines and Health-Related Fitness in Youth.

  James R Morrow, Jacob S Tucker, Allen W Jackson, Scott B Martin, Christy A Greenleaf, Trent A Petrie
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  ABSTRACT: BACKGROUND: National physical activity guidelines have been developed for Americans. Interest lies in the relationship between meeting the national physical activity guidelines and physical fitness outcomes in youth. Theoretically, those who meet the physical activity guidelines are more physically fit, which translates to better health and reduced risk. PURPOSE: To examine the relationship between youth self-reported physical activity behaviors sufficient to meet DHHS Physical Activity Guidelines for Americans and an external health criterion: achievement of the Fitnessgram(®) Healthy Fitness Zone™ (HFZ). METHODS: Logistic regression was used to examine achievement of the HFZ for three physical fitness measures (i.e., aerobic capacity, BMI, and muscle fitness) separately, and for all three combined, based on self-reported physical activity of 7 days per week for aerobic activity and ≥3 days per week of muscle-strengthening activity. One model examined the direct relationship between physical activity and fitness measures, and a second model assessed the same relationship while controlling for gender, age, ethnicity, economic status, and school. Data were collected during the 2009-2010 academic year and analyzed in 2012. RESULTS: Adolescents failing to meet national aerobic and muscle-strengthening physical activity guidelines have higher odds of not achieving healthy physical fitness levels of aerobic capacity, BMI, muscle fitness, and the combination of all three. An increase in the number of days of aerobic activity was related to decreased odds of being in the Needs Improvement Fitness Zone. CONCLUSIONS: The findings provide further support that meeting the national physical activity guidelines produces health benefits for youth.
  American journal of preventive medicine 05/2013; 44(5):439-444.
• Article: Pre-Sliced Fruit in School Cafeterias: Children's Selection and Intake.

  Brian Wansink, David R Just, Andrew S Hanks, Laura E Smith
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  ABSTRACT: BACKGROUND: It is often assumed that children avoid fruit in school cafeterias because of higher relative prices and preferences for other foods. Interviews with children reveal that eating whole fresh fruit can be difficult for those with small mouths or braces. Older girls find whole fruits messy and unattractive to eat. PURPOSE: To determine the effect of offering pre-sliced fruit in schools on selection and intake. DESIGN: Three of six schools were assigned randomly to serve apples in slices. Three control schools served apples whole. Selection, consumption, and waste of apples were measured prior to and during treatment. SETTING/PARTICIPANTS: Cafeterias in six public middle schools in Wayne County NY in 2011. Participants included all students who purchased lunch on days when data were collected. INTERVENTION: Treatment schools were provided with a standard commercial fruit slicer, and cafeteria staff members were instructed to use it when students requested apples. Trained researchers recorded how much of each apple was consumed and how much was wasted in both control and treatment schools. MAIN OUTCOME MEASURES: Daily apple sales, percentage of an apple serving consumed per student, and percentage of an apple serving wasted per student. RESULTS: Data were analyzed in 2012. Schools that used fruit slicers to pre-slice fruit increased average daily apple sales by 71% compared to control schools (p<0.01). The percentage of students who selected apples and ate more than half increased by 73% (p=0.02) at schools that served pre-sliced fruit, and the percentage that wasted half or more decreased by 48% (p=0.03). CONCLUSIONS: Sliced fruit is more appealing to children than whole fruit because it is easier and tidier to eat. This study applies the principle of convenience from behavioral economics and provides an example of a scalable, low-cost environmental change that promotes healthy eating and decreases waste.
  American journal of preventive medicine 05/2013; 44(5):477-480.
• Article: Premature Mortality Patterns Among American Indians in South Dakota, 2000-2010.

  Mathew Christensen, Lon Kightlinger
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  ABSTRACT: BACKGROUND: American Indians in South Dakota have the highest mortality rates in the nation compared to other racial and ethnic groups and American Indians in other states. PURPOSE: Cause-related and age-specific mortality patterns among American Indians in South Dakota are identified to guide prevention planning and policy efforts designed to reduce mortality within this population, in both South Dakota and other parts of the U.S. METHODS: Death certificate data from South Dakota (2000-2010), on 5738 American Indians and 70,580 whites, were used to calculate age-specific mortality rates and rate ratios. These values were examined in order to identify patterns among the leading causes of death. Analyses were completed in 2011 and 2012. RESULTS: Within the South Dakota population, 70% of American Indians died before reaching age 70 years, compared to 25% of whites. Fatal injuries and chronic diseases were the leading causes of premature mortality. Nine leading causes of death showed consistent patterns of mortality disparity between American Indians and whites, with American Indians having significantly higher rates of mortality at lower ages. CONCLUSIONS: Premature mortality among American Indians in South Dakota is a serious public health problem. Unified efforts at the federal, tribal, state, and local levels are needed to reduce premature death within this population.
  American journal of preventive medicine 05/2013; 44(5):465-471.
• Article: Weight-Related Child Behavioral Interventions in Brazil: A Systematic Review.

  Simon J Marshall, Eduardo J Simoes, Christina M Eisenberg, Christina K Holub, Elva M Arredondo, Simón Barquera, John P Elder
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  ABSTRACT: CONTEXT: Between 1974 and 1997, the prevalence of overweight increased 300% among Brazilian children and adolescents. A systematic review was conducted between January 2010 and December 2011 of obesity-related interventions targeting Brazilian children and adolescents. EVIDENCE ACQUISITION: Manuscripts from 1965 to December 2010 were evaluated based on inclusion criteria including evaluating obesity-related outcomes and at least 50% of participants living in Brazil. Methods were adapted from the CDC's Community Guide. Evidence was based on the number of available studies, study design, execution, quality, and effect size. EVIDENCE SYNTHESIS: Sixteen articles were abstracted; five met final inclusion criteria. All intervention samples (range n=14-78; mean n=40.6) included overweight or obese children aged 8-17 years. The intervention duration range was 3-6 months, and dose frequency ranged from two to five times per week. Three of the five interventions included healthy eating and physical activity; two included only physical activity. Two interventions studies were rated as having greatest design suitability. Only one intervention had the greatest design suitability and a large effect size. CONCLUSIONS: Intervention approaches that combined physical activity and healthy eating had the strongest effects. However, small sample bias, 95% CIs of primary effects, and poor-to-moderate quality of research designs and implementation suggest the combined evidence is best rated as Insufficient. This prohibits the recommendation of specific strategies or settings. Findings suggest that more well-designed evidence-based childhood obesity interventions in Brazil are needed and that promising, but yet unproven, interventions should be evaluated rigorously.
  American journal of preventive medicine 05/2013; 44(5):543-549.
• Article: Strategies to Reduce Obesity in the U.S. and Latin America: Lessons That Cross International Borders.

  John P Elder, Elva M Arredondo
  American journal of preventive medicine 05/2013; 44(5):526-528.
• Article: Insurance Coverage for Weight Loss: Overweight Adults' Views.

  Marian P Jarlenski, Kimberly A Gudzune, Wendy L Bennett, Lisa A Cooper, Sara N Bleich
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  ABSTRACT: BACKGROUND: Given the prevalence of obesity and associated chronic conditions among U.S. adults, wellness benefits are an increasingly popular approach to promoting weight loss. PURPOSE: The goal of the study was to assess overweight and obese adults' beliefs about the helpfulness of insurance coverage of weight loss-related benefits, their willingness to pay for such benefits, and whether these opinions differ by individuals' weight or health insurance type. METHODS: A national survey was fielded in 2012 among non-pregnant, overweight, and obese adults who had seen a primary care provider in the past year (n=600). Descriptive statistics summarized beliefs about which weight loss-related benefits would be helpful, willingness to pay for such benefits, and agreement about whether health insurers should be able to charge more to obese individuals. Multivariable logistic regression was employed to determine whether beliefs differed by weight category or health insurance type. Analyses were conducted in July 2012. RESULTS: The majority (83%) of respondents cited a specific benefit as helpful. Those with private health insurance had a higher probability (89%, 95% CI=86%, 93%) of endorsing any benefit as helpful relative to those with other types of health insurance. Being obese relative to overweight was associated with greater support (57% vs 39%, p<0.05) for preventing health insurers from charging higher premiums to obese individuals. CONCLUSIONS: In this sample of overweight adults, a large proportion endorsed the value of weight loss-related benefits offered by health plans. However, only about one third were willing to pay extra for them, and half disagreed with the notion that health plans should charge more to obese individuals. Given evidence of their effectiveness, wellness benefits should be offered to all individuals.
  American journal of preventive medicine 05/2013; 44(5):453-458.